The treatment of aggressive clients often focuses on treating the
underlying or comorbid psychiatric diagnosis such as schizophrenia or bipolar
disorder. Successful treatment of comorbid disorders results in successful
treatment of aggressive behavior. Lithium has been effective in treating
aggressive clients with bipolar disorder, conduct disorders (in children), and
mental retardation. Carbamazepine (Tegretol) and valproate (Depakote) are used
to treat aggression associated with dementia, psychosis, and per-sonality
disorders. Atypical antipsychotic agents such as clozapine (Clozaril),
risperidone (Risperdal), and olan-zapine (Zyprexa) have been effective in
treating aggressive clients with dementia, brain injury, mental retardation,
and personality disorders. Benzodiazepines can reduce irritability and
agitation in older adults with dementia, but they can result in the loss of
social inhibition for other aggressive clients, thereby increasing rather than
reducing their aggression.
Haloperidol (Haldol) and lorazepam (Ativan) are com-monly used in
combination to decrease agitation or aggres-sion and psychotic symptoms.
Patients who are agitated and aggressive but not psychotic benefit most from
loraze-pam which can be given in 2-mg doses, every 45 to 60 minutes (Garlow,
Purselle, & D’Orio, 2006). Goedhard and associates (2006) found that
atypical antipsychotics were more effective than conventional antipsychotics
for aggressive, psychotic clients. Use of antipsychotic medica-tions requires
careful assessment for the development of extrapyramidal side effects, which
can be quickly treated with benztropine (Cogentin).
Although not a treatment per se, the short-term use of seclusion or
restraint may be required during the crisis phase of the aggression cycle to
protect the client and oth-ers from injury. Many legal and ethical safeguards
govern the use of seclusion and restraint .